Male Suicide

By Gerry Hickey

 

The topic of suicide is one which has
to be spoken of in the contrasting
manners of honesty and sensitivity.
There are many who have been affected
by the loss of a loved one in such
a manner. There are those too who have
suffered the shock of the attempted suicide
of a loved one and there are those who
themselves have survived an attempt. People
bereaved by suicide speak of the confusion,
shame, anger and loneliness they
experience and many speak of fleeting moments
of suicidal thoughts associated with
their grieving. It is always difficult to persuade
families bereaved by suicide to accept
that no one is to blame when a suicide
occurs. No blame attaches to anyone in a
case of suicide. People who take their own
lives are not intent on ending their lives so
much as ending the pain they are suffering.
They see no other way out of their suffering
than to take their own lives. We need to be
sensitive towards the feelings of those left
behind and to survivors.
However the depth of sensitivity must not
mask the honesty and openness required in
trying to understand the position and improve
our society’s ability to make the possibility
of suicide less prevalent.
In October 2005, I had the honour of addressing
the Dail Joint Committee on Health
and Children on this issue. Their report,
published in July 2006, made some very
disturbing reading.
Although suicide rates in Ireland were ranked
18th out of the then 25 EU States, our rate
of youth suicide (those in the age group 15
– 24 years) was ranked 5th highest. And in
this group, male self-harm deaths exceeded
those of females by a ratio of 7:1. While the
total rate of female suicide has remained
fairly consistent since 1990 there has been
a notable increase in male rates for the corresponding
period.
The indications are that there has been a
consistent rise in more recent years particularly
among young men.
The issues regarding men and suicide are
complex but certain indicators can be extracted
from the data to help us understand
the position more and ultimately take some
action.
Men who already have a mental health issues
are at a greater risk, along with those
experiencing depression.

Depression
Depression, which is estimated to affect
7 percent of men in any given year, is an
important risk factor for suicide. But male
depression is considered to be under diagnosed,
partly because men are less likely
than women are to seek treatment for it. In
addition, men don’t always develop standard
symptoms such as sadness, worthlessness
and excessive guilt. Instead, they may
be more likely to complain of fatigue, irritability,
sleep disturbances and loss of interest
in work or hobbies. Alcohol abuse, which is
more common in men, can mask depression
and make it more difficult to diagnose.
Sadly, it remains true that most men are
not good at showing some emotions or
sharing their feelings. When there is danger
of emotional exposure many men will
flee into some form of distraction such as
work or sport. Ironically, of late, the sport
option seems to be less safe as spontaneous
outbursts of opportunistic emotion are
frequently witnessed on the pitch and on
the terraces. But either way of dealing with
emotional expression is not as healthy as
the appropriate expression where it belongs.
That is to say, being able to cry when
it’s appropriate as well as laughing when
fitting.
Many men who are depressed have serious
issues surrounding their younger years
or feel “hard done by” although they may
not be consciously aware of this. Most consider
that the past is over and feel a need
to “get over it and move on”. It’s not that
simple. For hurt men, acknowledging that
pain and externalising it in the safety of a
professional therapist’s setting helps them
to make peace with the past first and then
move on.
Much of men’s depression and other mental
health issues are reactive. That is to say
they are caused by reaction to circumstances
or events in their lives or environment.
Joyous emotions attached to winning and
successes are unproblematic to express
and are generally accepted by peers. But
the more publicly perceived uncomfortable
emotions of sadness and vulnerability are
frequently kept well under wraps through
fear of rejection. Anger and frustration are
often either buried or expressed in inappropriate
manners. Learning to deal with such
emotions in a positive manner through talking
about them is an important part of the
solution.
However, many internalise those feelings,
letting them build up and over time they become
emotionally toxic causing depression.
Repressed anger and frustration contribute
greatly to reactive depression. Frequently
the build up gets too much and overflows
exploding in the guise of flash anger. These
are situations where someone looses their
temper in a totally “over the top” manner
as a response to something minor. Roadrage,
queue-rage and unprovoked attacks
are indicators of such irrational responses.
These episodes are very disconcerting for
all involved and the people who live with
or are closely involved with such a person
themselves become anxious and stressed.
They experience the preverbal “walking on
eggshells” routine in what ought to be the
comfort of their own home.

 

Alcohol
My presentation to the Committee concentrated
on the alcohol issue. Alcohol plays a
part in 47% of male episodes of deliberate
self-harm. With this in mind the issue needs
to be taken seriously as this is undoubtedly
part of the solution. During the 1990s Ireland
experienced a 41% increase in alcohol
consumption and suicide rates increases by
44%. Are the two connected? The effect
of drinking on the younger person’s brain
causes a greater depletion in important
mood stabilising neurotransmitters than occurs
in a mature adult brain. High levels of
“spree” type drinking can lead to inducing
significant depressed mood states over a
subsequent 8 to 12 hour period. Research
shows that the relative risks of suicide increase
10 fold after a drinking spree. Liberal
licensing laws, peer and cultural pressure
and increased availability contribute further
to this situation.
Depression is closely associated with problem
drinking and in many cases it’s not
clear what comes first, problem drinking or
depression. In such cases it is preferable
that the alcohol be abstained from for a
considerable period so as to enable better
insight into natural mood conditions.
There is much written about the changing
roles of men resulting from the changing
roles of women. And indeed there is some
truth in saying that this has altered positions
and attitude. But I suggest that what
has really happened in the last 20 years is
that a huge expectation has developed on
men to show their feelings. That expectation
has in turn put enormous pressure
on men to be more open and emotional
in public. There are mixed messages here.
Unfortunately being real, is sometimes seen
as being vulnerable, weak and “feminine”.
Some appear to get sadistic pleasure in
seeing a man appropriately respond emotionally
to a situation. So when we get the
desired emotional response we easily slag
off the bloke because of our unease. Who
can forget the tears of Paul Gascoigne and
the way the tabloids treated him? Real men
do cry, however demanding emotional reactions
from men on cue may not be the
healthiest long-term solution either.

Teenage Males
For teenagers males times can be difficult.
Emotional and physical development brings
the turmoil associated with body changes
and a desire for independence. Problems
with drugs and alcohol, the law, peer pressure
and school are common at this point
in life and are associated with a higher risk.

Factors linked to suicide and attempted suicides
in young males are:
Alcohol and other drugs which affect thinking
and reasoning ability and can act as
depressants. They decrease inhibitions,
increasing the likelihood of a depressed
young man making a suicide attempt. American
research has shown that one in three
adolescents is intoxicated at the time of an
attempt.
There is much debate over the role of academic
pressure in suicide and causal links
have not been established but there is little
doubt they exist.Young people who suffer, or have suffered,
abuse in the past are often at increased
risk of suicide or deliberate self-harm.

Older Men
At the other end of the spectrum, getting
older brings much loss for many people.
Loved ones and friends pass on; ill health
and loss of independence are more common.
Tragically, for many this usually culminates
in social isolation as older people
are forgotten about and ignored.
Risk factors for such people are:
-Living alone and feeling isolated, whether
because of separation, choice or bereavement,
often makes people question if life
is worth living.
-A painful chronic illness that prevents
someone getting on with their life could
flag up the possibility that a person is
more likely to consider suicide as a solution
to their problems.
-Depression as already mentioned
-Feelings of hopelessness and guilt

A UK study of suicide in the over 65s
showed that in approximately one third of
cases, alcohol had been used to “facilitate”
the suicide and 10% of those who killed
themselves were addicted to alcohol.

Marginalised Groups
The vulnerabilities of marginalised groups
especially those liable to community harassment
render them at risk of suicide behaviour.
Young men of same sex orientation
have been identified as one of a number of
high-risk groups for youth suicide. They are
more than 6 times more likely to engage in
suicidal behaviour than their heterosexual
peers. Many will never even have discussed
their orientation with anyone.

Separated Fathers
The situation of the “separated father” is
frequently commented on and many do
live apart from their children with little and
tightly controlled access. The Dail Committee
report specifically refers to this situation.
It comments that such “detached”
adult males are at increased risk of suicide.
It goes on to say “male children who are
raised without paternal involvement have
a great likelihood of youth suicide”. Despite
the other factors involved, it is reasonable
to assume that fathers access to
and involvement with their children leads
to healthier outlooks as far as suicide is
concerned.

Where A Threat Exists
For those who live with the threat of someone’s
suicide it can be very difficult. There are
people who would argue that if somebody is
intent on killing themselves then there’s little
any of us can do to prevent it. To a degree
this may be true, but it doesn’t mean
we should sit back and let them get on with
it. Try and get the person to talk about the
way they’re feeling, why they want to die, and
just listen to them. There’s no need to dive in
with miraculous solutions to their problems. A
person considering suicide needs support, understanding
and to know there’s professional
help available for them.
It’s important that the person offering support
knows they’re not alone in this too. It can be
a frightening and worrying experience to go
through. Sometimes it’s a good idea to get a
friend or trusted relative to intervene.

Overall people at risk of suicide tend to:
• Be depressed, moody, socially withdrawn
or aggressive
• Have suffered a recent life crisis
• Show changes in personality
• Feel worthless
• Abuse alcohol or other drugs
• Have frequent thoughts about death
• Talk about death and self-destruction
• Isolate and withdraw

If you find yourself avoiding others, feeling
hostile and worthless, thinking about
death and using alcohol or other drugs to
numb your pain, talk with your doctor. In
an urgent situation, an A&E ward or the
Samaritans can help. Friends or family
members may be the first to notice your
uncharacteristic behaviour. Take their advice
and seek help.

If you seek a private therapist I would suggest
speaking with your GP who will be
familiar with a therapist they have faith
in. The following groups are excellent in
their help and advice, The Samaritans on
1850-609090, AWARE on 1890-303302 and
the Irish Association of Suicidology has a
wealth of information on their website, www.ias.ie
www.gerryhickey.com